Ischaemic strokes – how to recognize and treat them

In order to tackle cardiovascular complications that cause ischaemic strokes, professionals at Sukumvit Hospital use cutting-edge technology to ensure holistic treatment. A recent case described how a patient aged 60 years old had been suffering from cardiac arrhythmias (irregular heart beat) for ten years, but one day when he was at home, he experienced a sudden onset of dizziness and a sharp stabbing pain in the head that forced him to sit down to avoid collapsing. Luckily, in less than an hour, his wife returned home and quickly rushed him to Sukumvit Hospital. When the patient arrived at the hospital he was experiencing weakness and numbness in his limbs.

After an initial examination by medical professionals, he was put through magnetic resonance imaging (MRI) to scan the brain. From the results, it became evident that the patient had blood clots in his brain that caused an ischaemic stroke. Doctors then had to swiftly plan how to treat both the cardiac arrhythmia and stroke, simultaneously. This particular patient suffered from a heart rate that was sometimes too fast and sometimes too slow, fluctuating between atrial fibrillation and bradycardia. An arrhythmia can result in blood not being properly pumped out of the heart, leaving it to pool and form a clot that can travel to the brain and cause a stroke.

The importance of multidisciplinary treatment:

Moving forward, two doctors at Sukumvit Hospital teamed up, using their comprehensive knowledge about neurology to successfully diagnose and treat the patient. The first, Dr. Jackree Thanyanopporn is a specialist in the field of interventional neuroradiology, which describes the subspecialty of radiology that focuses on diagnosing abnormalities using neuroimaging techniques. After performing initial blood work and scans to conclude the patient had blood clots, Dr. Jackree swiftly began treatment. The first step was to give the patient recombinant tissue plasminogen activator (tPA), a medicine that should dissolve clots within an hour of being administered. However, after 45 minutes of receiving the medication, the patient’s symptoms began to worsen and doctors feared that the medicine might have increased internal bleeding.

Further tests were then carried out so that doctors could ensure the brain was still reparable. To do this, doctors use either computed tomography (CT scan) or an MRI. The additional scan showed that less than 20% of the brain was damaged, however, the blood vessels were still clogged. An alternative treatment was then put in place to retrieve the clot in a non-invasive manner. To do this, surgeons used a process called mechanical thrombectomy, which involves making a small incision to gain access to the arterial tree, navigating a catheter up to vessels in the brain, and then using a suction and/or stent-like device to remove the clot from the body. Considering Dr. Jackree performed the clot retrieval as soon as possible, the patient was in the surgery room for less than three hours and his recovery outlook looked positive. Moreover, this method of removing the clot has several benefits as there is less post-stroke disability and improved functional independence after the crucial 90 day recovery period. The case also reiterated the importance of a multidisciplinary approach to treatment, where the knowledge from various doctors is combined with up-to-date technology to guarantee success.

Rehabilitation is crucial:

Another doctor who treated the patient was Dr. Juksanee Thanyanopporn, a specialist in neurology. She explains that one a patient is discharged from the ICU, the individual is then moved to one of the recovery rooms where, if they are dealing with any abnormalities like weakness or unclear speech, they can use various forms of rehabilitation to speed up the recovery process. Examples of these include physical therapy, speech therapy and occupational therapy, which helps patients improve their sensory and motor abilities. Moreover, because the cause of a stroke differs from patient to patient, it is critical to understand the patient’s condition fully before curating a rehabilitation programme. Ischaemic strokes happen as a result of various factors, including high blood pressure, diabetes and smoking, which can lead to the development of heart conditions and consequently, blood clots. Dr. Juksanee also discussed the importance of supervision during recovery, stating that ischaemic stroke patients are often at risk of it happening again.

Therefore, from research about how individuals are prone to relapses, a lot of successful recovery really depends on the aftercare a patient receives during the first three months, as the majority of neurological recovery happens during this period.

Sukumvit Hospital which began its operations in 1977, recently completed a major makeover. Not only have they built a new building, but the entire team of doctors, specialists, nurses and assistants have all been trained with the singular aim of helping their patients maintain optimum health. Then there are the equipment, state-of-the-art MRIs, Cath labs and myriad of others so that their specialists have the best available tools for diagnosis and treatment. Conveniently located on Sukhumvit Road with English speaking staff, Sukumvit Hospital is now ready for any emergencies or treatments.

Sukumvit Hospital
1411 Sukhumvit Road (Ekkamai BTS) Phrakanong Nua, Wattana, Bangkok, Thailand 10110 Tel: 02 391 0011  

Website: www.sukumvithospital.com  Facebook: @sukumvithospital